I, Fuleswar Barman, son of Thelthala Barman, resident of Gadoler Kuthi, Mathabhanga, Cooch Behar, West Bengal, hereby state that I am applying for my daughter Sampa Barman’s birth certificate. She was born on 13/05/2005 at our own residence, as confirmed vide affidavit before E.M. Court, Mathabhanga dated 19/06/2026. My daughter is a person with disability.